Determinants of gingival overgrowth severity in organ transplant patients
The aim of this study was to evaluate the role of HLA phenotype as a risk factor in patients with drug-induced gingival hyperplasia in isolation and in identified risk factors. In organ transplant patients who were medicated with either cyclosporin or a combination of cyclosporin and a calcium-blocking drug the relationship of the gingival changes relative to demographics, drug pharmacokinetics, and periodontal variables was studied. Drug histories were obtained from 172 organ transplant patients, and the patients were grouped into those taking cyclosporin alone and those taking the combination of cyclosporin in conjunction with calcium channel-blocking drugs. Patients with a history of drugs known to cause gingival hyperplasia were excluded. Blood tests were performed to determine cyclosporin concentration and plasma creatinine levels two hours prior to examination. Measurements were made on the six most anterior teeth, gingival inflammation was evaluated, full-mouth impressions were taken to evaluate gingival overgrowth, and if a score of 30% was obtained, surgery was indicated. The results showed that if cyclosporin was used in conjunction with nifedipine, gingival overgrowth was significantly higher than if cyclosporin was used alone. In patients using only cyclosporin, there was a significantly higher level of plasma creatinine compared with those using a combination drug therapy. The age and sex of patient, duration of therapy, creatinine serum level, papilla bleeding index, and the combination of drugs were important determinants of the severity of the problem. With a 5% level of significance of HLAB37, it can be said that this HLA phenotype plays a role in drug-induced gingival hyperplasia. [A.S.]
Thomason, J.M., R.A. Seymour, J.S. Ellis, P.J. Kelly, J. Dark, R. Wilkinson, and J.R. Ilde, J Clin Periodont, 23:628,1996